Megavoltage Electronic Portal Imaging Device Research Articles

Automatic detection of graticule isocenter and scale from kV and MV images.

PurposeTo automate the detection of isocenter and scale of the mechanical graticule on kilo‐voltage (kV) or mega‐voltage (MV) films or electronic portal imaging device (EPID) images.MethodsWe developed a robust image processing approach to automatically detect isocenter and scale of mechanical graticule from digitized kV or MV films and EPID images. After a series of preprocessing steps applied to the digital images, a combination of Hough transform and Radon transform was performed to detect the graticule axes and isocenter. The magnification of the graticule was automatically detected by solving an optimization problem using golden section search and parabolic interpolation algorithm. Tick marks of the graticule were then determined by extending from isocenter along the graticule axes with multiples of the magnification value. This approach was validated using 23 kV films, 26 MV films, and 91 EPID images in different anatomical sites (head‐and‐neck, thorax, and pelvis). Accuracy was measured by comparing computer detected results with manually selected results.ResultsThe proposed approach was robust for kV and MV films of varying image quality. The isocenter was detected within 1 mm for 98% of the images. The exceptions were three kV films where the graticule was not actually visible. Of all images with correct isocenter detection, 99% had a magnification detection error less than 1% and tick mark detection error less than 1 mm, with the exception of 1 kV film (magnification error: 3.17%; tick mark error: 1.29 mm) and 1 MV film (magnification error: 0.45%; tick mark error: 1.11 mm).ConclusionWe developed an approach to robustly and automatically detect graticule isocenter and scale from two‐dimensionla (2D) kV and MV films. This is a first step toward automated treatment planning based on 2D x‐ray images.

Image-guided prostate radiotherapy: analysis of inter- fractional setup errors

Introduction: The accuracy of the patient setup and tumor location are major factors that determine the efficacy of radiotherapy treatment planning. In the prostate radiotherapy, reproducibility of the prostate location for each treatment fraction is problematic owing to varying filling of the rectum and bladder. According to this, the aim of this study was to measure the inter- fractional setup errors using gold markers implanted into the prostate and electronic portal imaging device (EPID). The results were used to determine optimal CTV-PTV (clinical target volume-planning target volume) margin. Materials and Methods: Image-guided three-dimensional conformal radiotherapy (3DCRT) was performed by daily online verification of implanted fiducial prostate markers using a megavoltage EPID. In this retrospective study, a total of 359 image-guided treatment fractions from 15 prostate cancer patients were analyzed. PTV was defined as an isotropic margin of 5 mm around of CTV. Daily electronic portal images (EPIs) compared to reference digitally reconstructed radiographs (DRRs), the setup errors were determined and online corrections applied. Mean displacements, population systematic and random errors were calculated. CTV-PTV margin was determined using van Herk’s formula. Results: The mean shifts in the vertical, longitudinal and lateral directions were 0.31 mm, 0.22 mm and – 0.41 mm, respectively. The population systematic and random errors in the three mentioned translational directions were 0.70 mm, 0.80 mm and 1.00 mm and 2.11 mm, 2.24 mm and 2.20 mm, correspondingly. CTV-PTV margin of 3.23 mm, 3.60 mm and 4.04 mm in the vertical, longitudinal and lateral directions were calculated. Conclusion: The calculated PTV margin was less than 5 mm, therefore PTV margin applied in this study provides a sufficient PTV coverage. Daily EPIs combined with gold markers implanted into the prostate provide an effective tool for verifying of the prostate position immediately prior to treatment delivery.

Enhancement of megavoltage electronic portal images for markerless tumor tracking.

PurposeThe poor quality of megavoltage (MV) images from electronic portal imaging device (EPID) hinders visual verification of tumor targeting accuracy particularly during markerless tumor tracking. The aim of this study was to investigate the effect of a few representative image processing treatments on visual verification and detection capability of tumors under auto tracking.MethodsImages of QC‐3 quality phantom, a single patient's setup image, and cine images of two‐lung cancer patients were acquired. Three image processing methods were individually employed to the same original images. For each deblurring, contrast enhancement, and denoising, a total variation deconvolution, contrast‐limited adaptive histogram equalization (CLAHE), and median filter were adopted, respectively. To study the effect of image enhancement on tumor auto‐detection, a tumor tracking algorithm was adopted in which the tumor position was determined as the minimum point of the mean of the sum of squared pixel differences (MSSD) between two images. The detectability and accuracy were compared.ResultsDeblurring of a quality phantom image yielded sharper edges, while the contrast‐enhanced image was more readable with improved structural differentiation. Meanwhile, the denoising operation resulted in noise reduction, however, at the cost of sharpness. Based on comparison of pixel value profiles, contrast enhancement outperformed others in image perception. During the tracking experiment, only contrast enhancement resulted in tumor detection in all images using our tracking algorithm. Deblurring failed to determine the target position in two frames out of a total of 75 images. For original and denoised set, target location was not determined for the same five images. Meanwhile, deblurred image showed increased detection accuracy compared with the original set. The denoised image resulted in decreased accuracy. In the case of contrast‐improved set, the tracking accuracy was nearly maintained as that of the original image.ConclusionsConsidering the effect of each processing on tumor tracking and the visual perception in a limited time, contrast enhancement would be the first consideration to visually verify the tracking accuracy of tumors on MV EPID without sacrificing tumor detectability and detection accuracy.

Image-guided intensity-modulated radiotherapy of prostate cancer: Analysis of interfractional errors and acute toxicity.

PurposeThe aim of the study was to estimate interfractional deviations in patient and prostate position, the impact of the frequency of online verification on the treatment margins, and to assess acute radiation reactions of high-dose external beam image-guided intensity-modulated radiotherapy (IG-IMRT) of localized prostate cancer.Patients and methodsIG-IMRT was performed by daily online verification of implanted fiducial prostate markers using a megavoltage electronic portal imaging device (EPID). A total of 1011 image-guided treatment fractions from 23 consecutive unselected prostate cancer patients were analyzed. The median total dose was 79.2 Gy (range 77.4–81.0 Gy). Acute radiation reactions were assessed weekly during radiotherapy using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.03.ResultsA relevant combined patient set-up and prostate motion population random error of 4–5 mm was observed. Compared to daily IGRT, image guidance every other day required an expansion of the CTV–PTV (clinical target volume–planning target volume) margin of 8.1, 6.6, and 4.1 mm in the longitudinal, vertical, and lateral directions, thereby, increasing the PTV by approximately 30–40 %. No grade 3 or 4 acute radiation reactions were observed with daily IG-IMRT.ConclusionA high dose with surprisingly low acute toxicity can be applied with daily IG-IMRT using implanted fiducial prostate markers. Daily image guidance is clearly superior to image guidance every other fraction concerning adequate target coverage with minimal margins.

SU-E-J-70: Evaluation of Multiple Isocentric Intensity Modulated and Volumetric Modulated Arc Therapy Techniques Using Portal Dosimetry

Purpose: To develop a method for verification of dose distribution in a patient during treatment using multiple isocentric Intensity modulated and volumetric modulated arc therapy techniques with portal dosimetry. Methods: Varian True Beam accelerator, equipped with an aS1000 megavoltage electronic portal imaging device (EPID) has an integrated image mode for portal dosimetry (PD). The source-to-imager distance was taken at 150 cm to avoid collision to the table. Fourteen fractions were analyzed for this study. During shift in a single plan from one isocenter to another isocenter, EPID also shifted longitudinally for each field by taking the extent of divergence of beam into the consideration for EPID distance of 150cm. Patients were given treatment everyday with EPID placed in proper position for each field. Several parameters were obtained by comparing the dose distribution between fractions to fraction. The impact of the intra-fraction and inter-fraction of the patient in combination with isocenter shift of the beams were observed. Results: During treatment, measurements were performed by EPID and were evaluated by the gamma method. Analysis was done between fractions for multiple isocenter treatments. The pass rates of the gamma analysis with a criterion of 3% and 3 mm for the 14 fractions were over 97.8% with good consistency. Whereas maximum gamma exceeded the criteria in few fractions (in<1 cc vol). Average gamma was observed in the criteria of 0.5%. Maximum dose difference and average dose differences were less than 0.22 CU and 0.01 CU for maximum tolerance of 1.0 CU and 0.2 CU respectively. Conclusion: EPID with extended distance is ideal method to verify the multiple isocentric dose distribution in patient during treatment, especially cold and hot spots in junction dose. Verification of shifts as well as the dose differences between each fraction due to inter-fraction and intra-fraction of the patient can be derived.

SU‐E‐J‐45: Verification of Beam‐Line Geometry of Truebeam Using MV‐EPID

Purpose: Geometrical accuracy of beam‐line components of a linear‐accelerator (LINAC) is indispensible for quality of patient treatments. Positional reproducibility of the flattening filters (FF) may directly affect the beam flatness and symmetry while uncertainties in the imager position may directly impact target localization. In this study we have investigated the positional uncertainties of both of these components. Methods: Images of both flattened and flatness‐filter‐free (FFF) beams of 6 and10 MV were acquired using the megavoltage electronic portal imaging Device (MV‐EPID) over a period of time to investigate the positional uncertainties in the beam‐line geometry. Due to forward peaked nature of the MV beams FFF beams show a cone‐shaped dose distributions that was used determine the center of the X‐ray beams and used as reference points. Central portion of the flattened beams show the image of the FF. These circular objects were used to determine the center of the flatness‐filter with respect to the reference point. Imager reproducibility was also tested against the reference point which is the center of the source. Positional reproducibility of the FF and the imager were tracked over a period of two months. Results: Centers of both 6X and 10X FFs were systematically shifted by 2.2mm in X‐and ‐ 0.7 in Y‐directions. However, the shifts were magnified due to the fact that the FF being close to the MV‐source while the imager is far away (at 108cm) from the source. When corrected for this magnification, the real uncertainty in the FF position is approximately 0.2mm and ‐ 0.06 mm in X‐and Y‐directions. The imager positional reproducibility was found to be within ±1 pixel (&lt;0.5mm). Conclusion: In this study we have shown a new method to detect positional uncertainty of the flatness‐filter and MV‐EPID. This methodology may be useful for QA of the LINACs. This project is supported by Varian Medical Systems

A simple method to quantify the coincidence between portal image graticules and radiation field centers or radiation isocenter

The aim of this study was to develop a computerized method to quantify the coincidence between portal image graticules and radiation field centers or radiation isocenter. Three types of graticules were included in this study: Megavoltage (MV) mechanical graticule, MV electronic portal imaging device digital graticule, and kilovoltage (kV) on-board imaging digital graticule. A metal ball bearing (BB) was imaged with MV and kV x-ray beams in a procedure similar to a Winston-Lutz test. The radiation fields, graticules, and BB were localized in eight portal images using Hough transform-based computer algorithms. The center of the BB served as a static reference point in the 3D space so that the distances between the graticule centers and the radiation field centers were calculated. The radiation isocenter was determined from the radiation field centers at different gantry angles. Misalignments of MV and kV portal imaging graticules varied with the gantry or x-ray source angle as a result of mechanical imperfections of the linear accelerator and its imaging system. While the three graticules in this study were aligned to the radiation field centers and the radiation isocenter within 2.0 mm, misalignments of 1.5-2.0 mm were found at certain gantry angles. These misalignments were highly reproducible with the gantry rotation. A simple method was developed to quantify the alignments of portal image graticules directly against the radiation field centers or the radiation isocenter. The advantage of this method is that it does not require the BB to be placed exactly at the radiation isocenter through a precalibrated surrogating device such as room lasers or light field crosshairs. The present method is useful for radiation therapy modalities that require high-precision portal imaging such as image-guided stereotactic radiotherapy.

A fully electronic intensity-modulated radiation therapy quality assurance (IMRT QA) process implemented in a network comprised of independent treatment planning, record and verify, and delivery systems

BackgroundThe purpose of this study is to implement an electronic method to perform and analyze intensity-modulated radiation therapy quality assurance (IMRT QA) using an aSi megavoltage electronic portal imaging device in a network comprised of independent treatment planning, record and verify (R&V), and delivery systems.MethodsA verification plan was generated in the treatment planning system using the actual treatment plan of a patient. After exporting the treatment fields to the R&V system, the fields were delivered in QA mode with the aSi imager deployed. The resulting dosimetric images are automatically stored in a DICOM-RT format in the delivery system treatment console computer. The relative dose density images are subsequently pushed to the R&V system. The absolute dose images are then transferred electronically from the treatment console computer to the treatment planning system and imported into the verification plan in the dosimetry work space for further analysis. Screen shots of the gamma evaluation and isodose comparison are imported into the R&V system as an electronic file (e.g. PDF) to be reviewed prior to initiation of patient treatment. A relative dose image predicted by the treatment planning system can also be sent to the R&V system to be compared with the relative dose density image measured with the aSi imager.ResultsOur department does not have integrated planning, R&V, and delivery systems. In spite of this, we are able to fully implement a paperless and filmless IMRT QA process, allowing subsequent analysis and approval to be more efficient, while the QA document is directly attached to its specific patient chart in the R&V system in electronic form. The calculated and measured relative dose images can be compared electronically within the R&V system to analyze the density differences and ensure proper dose delivery to patients.ConclusionsIn the absence of an integrated planning, verifying, and delivery system, we have shown that it is nevertheless possible to develop a completely electronic IMRT QA process.

SU‐GG‐J‐37: Assessing Image Guided Radiation Therapy Targeting Accuracy: Coincidence Of Imaging System Isocenter With Treatment Machine Mechanical And Radiation Isocenters

Purpose: The purpose of this study is to introduce a method for quantifying the accuracy of linac and imaging system isocenters and demonstrate its use by measuring the targeting of two kilovoltage (kV) imaging systems, and one gantry mounted megavoltage Electronic Portal Imaging Device (EPID). One is the kV imaging system (OBI) integrated with the linear accelerator which supports radiographic and cone beam CT imaging. The other system is the BrainLab Exac Trac stand alone fixed to the treatment room ceiling and floor. Method and Materials: A cylindrical Lucite phantom was designed and fabricated to perform this study. The cylindrical phantom is 20 cm in diameter and 20 cm long. The phantom contains 13 radio‐opaque fiducial markers. A 5 mm spherical marker is positioned at the center of the cylinder. The phantom was imaged and the CT data sets were imported to two planning systems. Treatment beams were placed and both 3D data sets and isocenter information were transferred to the Linac delivery and imaging workstations. For each imaging system, phantom was initially positioned according to machine cross‐hair. Then images were acquired and measured shifts were applied to precisely position the phantom. Then, Winston‐Lutz test was performed for different gantry and collimator configuration. The radiation beam was collimated by a tray‐mounted 30 mm diameter circular collimator. Results: The radius of spherical volume in which all isocenter intersect or lie was measured. For EPID, OBI, CBCT, and Exac Trac, the radius is: 0.54 mm, 1.4 mm, 1.7 mm and 1.46 mm respectively. From the Winston‐Lutz analysis, the average isocenter deviation from all angles is 1.18 ± 0.28 mm. Conclusion: The error in mechanical, radiation and imaging isocenter is about one millimeter. Regardless what imaging system is used for patient setup, it is important to incorporate this systematic error in any planning margins.